This study seeks to understand the barriers facing junior physician faculty researchers, and women in particular, in order to inform efforts to improve gender equity in academic medicine. Despite a dramatic increase in women's participation in the medical profession over the past four decades, women remain in the distinct minority in the senior positions of academic medicine. Some have dismissed these disparities as resulting from gender differences in preferences regarding the balance between work and other pursuits or between research and clinical activity. The proposed work focuses upon an extremely selective cohort of highly apt, research-oriented junior faculty members: physician-recipients of K08 and K23 mentored career development awards from the NIH. In so doing, it minimizes the impact of potential gender differences in the desire to pursue research and in access to monetary support, allowing for the impact of other challenges and barriers to be isolated. In a preliminary study, we discovered that female K08 and K23 awardees were significantly less likely to obtain a subsequent independent R01 grant than their male colleagues. In this application, we propose a mixed-methods and interdisciplinary study to illuminate why this disparity exists. Specifically, in order to identify the key elements of academic success and to investigate and promote gender equity among these highly motivated and accomplished physician-researchers, we propose a three-phase study. In the first phase, we will conduct a large-scale survey of the entire population of 1425 physicians receiving K08 and K23 Awards from the NIH in 2005-2008, in order to assess gender differences in access to critical resources, such as protected research time and mentoring. We will then proceed to conduct a qualitative analysis of interviews with 120 relevant stakeholders, including 60 former K08 and K23 recipients and their mentors. Finally, we will conduct a follow-up survey of the 1425 physicians receiving K08 and K23 Awards in 2005-2008 to determine which resources, individual, and institutional characteristics are associated with academic success, including publication, attainment of independent funding, satisfaction, promotion, and retention within academic medicine, as well as to identify which factors primarily mediate gender differences in these outcomes. In this way, this study will illuminate the key elements of academic success for men and for women, including revealing which elements are common and which are unique, allowing for the informed design of targeted interventions to improve gender equity in academic medicine. PUBLIC HEALTH RELEVANCE: Because women have different perspectives and different life experiences than their male colleagues, new ideas and approaches are likely to emerge from their participation in the academic enterprise. Faculty diversity is critically important for advancing the research, educational, and clinical missions of medical schools. Efforts to decrease disparities must be informed by an understanding of the mechanisms by which gender differences develop, as this application seeks to illuminate.